Bone elongating devices and methods of use

ABSTRACT

An implantable bone elongation device including an inner rod defining an internal cavity housing a rotational actuator having an output shaft connected to a lead screw disposed at the end of the inner rod and in threaded engagement with a threaded inner surface of an outer rod. Rotation of the lead screw converts rotation motion into linear motion resulting in telescopic movement of the outer rod relative to the inner rod. Rotational motion is converted into linear motion by components disposed in a parallel configuration thereby minimizing the overall length of the bone elongating device while maintaining a maximum stroke length. In various embodiments, additional components, such as electronic circuit boards, electrical power supply or battery power source, may be housed within the internal cavity formed by the inner rod. The bone elongation device of the present invention may be affixed to a bone in a variety of configurations including implantation into a medullary cavity of the bone, attached to an outer surface of the bone, or attached to the bone as an extramedullary plate.

CROSS REFERENCE TO RELATED APPLICATIONS

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STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

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COPYRIGHT NOTICE

A portion of the disclosure of this patent document contains material that is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or patent disclosure as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all rights whatsoever.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates generally to bone elongation devices, and more particularly to compact bone elongation devices and methods for use in lengthening a bone, and for scoliosis correction, in a pediatric patient.

2. Description of the Background Art

Distraction osteogenesis is a surgical technique for lengthening a bone. Distraction osteogenesis consists of a controlled osteotomy followed by gradual and controlled distraction of the two bone ends utilizing a mechanical device which applies a stretching force to stimulate new bone growth. During the distraction phase, a distraction device causes distraction of the two bone segments starts at a specific rate and rhythm, typically at 1.0 mm per day.

Various distraction devices are known in the art. U.S. Patent Application Publication No. 2016/0058483 (Stauch), discloses a medullary pin for lengthening tubular bone comprising a hollow body containing axially displaceable first and second inner parts and a drive unit for generating axial displacement of the first inner part relative to the second inner part. An electrical cable provides power to the drive unit and allows for transmission of sensor signals from the device. U.S. Patent Application Publication No. 2011/0060336 (Pool) discloses an intramedullary lengthening device having an actuator with a housing containing a rotatable permanent magnet actuator and a movable distraction shaft telescopically mounted relative to the housing, wherein the distraction shaft is operatively coupled to the rotatable permanent magnet via a lead screw. U.S. Patent Application Publication No. 2017/0333080 (Roschak) discloses a remotely adjustable interactive bone reshaping implant including an implant body, an actuator coupled to the implant body, a sensor configured to detect a parameter indicative of a biological condition, a transceiver, and a controller.

Early onset scoliosis (“EOS”) presents another bone-related issue wherein a deformity of the spine, particularly affecting children before the age of complete lung maturation, i.e. between 8-10 years of age. The management of EOS remains challenging since therapeutic approaches are largely directed to reducing and controlling the spinal curvature while maintaining and allowing for growth of the spine and thorax. Growing rods are one a popular treatment option for EOS because they can prevent curve deterioration while allowing spinal growth. Traditionally, growing rods require open manual distractions approximately every 6 months. These open manual distractions are burdened by increased risk of anesthetic and wound complications. Repeated surgery under general anesthesia also has potential deleterious effects on brain development. This is especially important for young children. As a result of the disadvantages associated with traditional growing rods (TGR's), the background art reveals the development of alternative technologies.

The published application to Chang et al. (US 2014/0031870), discloses a magnetically controlled growing rod (“MCGR”) to allow for gradual lengthening on an outpatient basis. The MCGR allows for periodical noninvasive spinal lengthening under continuous neurological observation in an awake patient by use of a large external magnet. The published application to Kiester (US 2006/0009767) discloses correction of a scoliotic curve in a spine using an expanding rod isolated completely under the skin and attached to selected portions of scoliotic curve of the spine at opposite ends of the rod; and producing a controlled force by means of expansion of the rod over at an extended time period under external control until a desire spinal curve is obtained. The published application to Ross (US 2015/0250505) discloses a remotely controllable growing rod device containing on-board electronics with a microprocessor configured to receive remotely transmitted movement data through the receiver and further for feedback-controlled actuation of the drive assembly.

Unlike TGRs, the above-referenced technologies can be distracted during outpatient clinic visits, thereby avoiding the risks of repeated surgical lengthening. There is also the possibility for distractions to be carried out more frequently to mimic normal physiological growth more closely. This presents huge benefit for children as rod distractions no longer need to be carried out under general anesthesia. This may provide additional advantages to spine length gains by avoiding spine auto-fusion associated with sudden and forceful surgical distractions at irregular intervals. There remains, however, a need for further advancement in the art for device miniaturization, personalized protocols, and post-operative care follow-up.

While the various devices known in the art are generally suited for the specific uses for which they are intended, they are generally considered too large for use in treating pediatric cases. Further, the designs and mechanism used by the devices in the background art are generally not suitable for miniaturization to accommodate the smaller dimensions of pediatric bones without significant reductions in stroke length. In particular, due to a construction wherein the actuator is inside the outer rod and actuates the inner rod via a leadscrew disposed within the inner rod, the bone lengthening devices of the prior art relies on mechanical actuation wherein mechanical structure for ensuring and converting rotational motion to linear motion are configured in series, thereby resulting in a device having an excessive overall length. Accordingly, there exists a need for advancements in the field of bone lengthening to effectively treat pediatric cases.

Any art described in this section is not intended to constitute an admission that any patent, publication or other information referred to herein is “prior art” with respect to this invention, unless specifically designated as such. In addition, this section should not be construed to mean that a search has been made or that no other pertinent information as defined in 37 C.F.R. § 1.56(a) exists.

BRIEF SUMMARY OF THE INVENTION

The present invention overcomes the limitations present in the background art by providing advancements in the field of bone elongating devices and methods specifically adapted for use in lengthening the bones of pediatric subjects and treatment of pediatric scoliosis. In accordance with a first embodiment, the present invention provides an implantable bone elongation device including an outer rod and an inner rod configured in threaded telescopic engagement. The inner rod defines an internal cavity housing a rotational actuator having an output shaft connected to a lead screw disposed at the end of the inner rod and in threaded engagement with the threaded inner surface of the outer rod. Rotation of the lead screw converts rotation motion into linear motion resulting in telescopic movement of the outer rod relative to the inner rod. A significant aspect of the present invention is providing a configuration wherein the actuator is disposed inside the inner rod and actuates the outer rod thereby minimizing the overall length of the bone elongating device while maintaining a maximum stroke length. In various embodiments additional components, such as electronic circuit boards, and an electrical power supply or battery power source, may be housed within the internal cavity formed by the inner rod. The bone elongation device of the present invention may be affixed to a bone in a variety of configurations including implantation into a medullary cavity of the bone, attached to an outer surface of the bone, or attached to the bone as an extramedullary plate.

Accordingly, it is an object of the present invention to provide advancements in the field of bone elongating devices and methods.

It is another object of the present invention to provide an improved bone elongating device specifically configured for use in lengthening the bone of a pediatric patient.

Still another object of the present invention is to provide a bone elongating device wherein the mechanical structures for ensuring and converting rotational motion to linear motion are configured in parallel thereby minimizing overall retracted length while maintaining a maximum stroke length.

Yet another object of the present invention is to provide advancements in the art of treating early onset scoliosis.

These and other objects are met by the present invention which will become more apparent from the accompanying drawing and the following detailed description of the drawings and preferred embodiments.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

FIG. 1 is a schematic cross-sectional illustration of a prior art bone elongating device having an actuator and lead screw assembly in threaded engagement with an inner rod, in series, to ensure and translate rotational motion into linear motion;

FIG. 2 is a schematic cross-sectional illustration of a bone elongating device in accordance with the present invention with an actuator and lead screw configured in parallel relative to an outer rod to ensure and translate rotational motion into linear motion;

FIG. 3A is a schematic cross-sectional illustration of a bone elongating device in accordance with the present invention in a retracted configuration;

FIG. 3B is a schematic cross-sectional illustration in accordance with the device illustrated in FIG. 3A in a lengthened configuration;

FIG. 3C is a partial schematic detailed view of the device illustrated in FIG. 3B;

FIG. 3D is an exploded partial schematic detailed view of the device illustrated in FIG. 3C;

FIG. 4 is a schematic cross-sectional illustration of an alternate embodiment bone elongating device in accordance with the present invention configured with an electric motor and reducer;

FIG. 5 is a schematic cross-sectional illustration of an alternate embodiment bone elongating device in accordance with the present invention configured with a rotational actuator and an electronic circuit;

FIG. 6 is a schematic cross-sectional illustration of an alternate embodiment bone elongating device in accordance with the present invention configured with an internal power source;

FIG. 7 is a schematic cross-sectional illustration of an alternate embodiment bone elongating device in accordance with the present invention configured with an implantable remote powering module;

FIG. 8 is a schematic cross-sectional illustration of an alternate embodiment configured with a bearing;

FIGS. 9A and 9B are schematic cross-sectional illustrations of alternate embodiments configured with various seals;

FIG. 10 is a schematic cross-sectional illustration of an alternate embodiment configured with a vent;

FIG. 11 is a schematic cross-sectional illustration of an alternate embodiment configured with a radially enlarged inner rod tip;

FIG. 12A is a schematic cross-sectional illustration of an alternate embodiment configured with a sheath in a fixed assembly with the inner rod and covering the outer rod;

FIG. 12B is a schematic cross-sectional illustration of another alternate embodiment sheath configuration with the device in a retracted configuration;

FIG. 12C is a schematic cross-sectional illustration of the embodiment shown in FIG. 12B but a partially extended configuration;

FIG. 13 is a schematic cross-sectional illustration of an alternate embodiment configured with a guide bushing;

FIG. 14 is a schematic cross-sectional illustration of an alternate embodiment configured with fillet ends;

FIG. 15 is a partial cross-sectional detailed illustration providing a detailed depiction of structure that allows sliding engagement between the inner and outer rods;

FIGS. 16A and 16B are schematic cross-sectional illustrations showing inner and outer rod ends adapted with fastener receiving apertures for use in attaching the device to a bone segment;

FIG. 17 is a schematic cross-sectional illustration depicting the device adapted with lateral fixation plates;

FIGS. 18A and 18B are comparative views of a prior art device (18A) and the device in accordance with the present invention (18B) illustrating the compact length of the present invention in the retracted configuration;

FIGS. 19A and 19B are comparative views of a prior art device (19A) and the device in accordance with the present invention (19B) illustrating the longer stroke length achieved by the present invention;

FIGS. 20A and 20B are comparative views of a prior art device (20A) and the device in accordance with the present invention (20B) illustrating the longer guiding length achieved by the present invention for the same stroke length achieved by a prior art device;

FIGS. 21A and 21B are comparative views of a prior art device (21A) and the device in accordance with the present invention (21B) illustrating the greater internal volume available for housing electro-mechanical systems in the present invention as compared with the prior art device;

FIG. 22 illustrates use of a bone lengthening device in accordance with the present invention as an intramedullary lengthening device;

FIG. 23 illustrates use of a bone lengthening device in accordance with the present invention as an extramedullary lengthening device;

FIG. 24 illustrates use of a bone lengthening device in accordance with the present invention as an extramedullary lengthening device associated with an intramedullary stiffener;

FIG. 25 illustrates another example of a bone lengthening device in accordance with the present invention as an extramedullary lengthening device;

FIG. 26 illustrates an embodiment of a bone lengthening device in accordance with the present invention in wireless communication with an external control unit;

FIG. 27 illustrates an embodiment of a bone lengthening device in accordance with the present invention configured for receiving power wirelessly and in wireless communication with an external control unit;

FIG. 28 illustrates an embodiment of a bone lengthening device in accordance with the present invention wired to an implantable powering module and configured for wireless external control;

FIG. 29 illustrates an embodiment of a bone lengthening device in accordance with the present invention wired to an implantable power receiving module and configured for wireless external control;

FIGS. 30A and 30B are cross-section illustrations of a bone lengthening device in accordance with the present invention in both the retracted and extended configurations;

FIGS. 31A and 31B are perspective cross-sectional illustrations of a bone lengthening device in accordance with the present invention in both the retracted and extended configurations;

FIG. 32 is an exploded perspective cross-sectional illustrations of a bone lengthening device in accordance with the present invention;

FIG. 33 is a partial perspective exploded view of inner and outer rod lugs for restricting rotational movement between the inner and outer rods;

FIG. 34 is a sectional view illustrating mating engagement of the inner and outer rod lugs;

FIG. 35 is a partial cross-sectional view of the device illustrating the inner rod lugs;

FIG. 36A is a cross-sectional view taken along line 36A-36A in FIG. 35 illustrating the partially threaded inner surface of the outer rod;

FIG. 36B is a cross-sectional view taken along line 36B-36B in FIG. 35 illustrating the partially threaded inner surface of the outer rod;

FIG. 37A is a side view illustrating through bores disposed at opposing ends of the device;

FIG. 37B is a perspective view thereof;

FIG. 38A is a side view illustrating an alternate through bore configuration at opposing ends of the device;

FIG. 38B is a perspective view thereof;

FIG. 39 is a side view illustrating through bores configured at perpendicular and oblique angles;

FIG. 40A is a side sectional view highlighting the distal and proximal axial stops;

FIG. 40B is a perspective sectional view thereof;

FIG. 41 illustrates an alternate configuration of the device with through bores defined in projecting flanges;

FIG. 42 illustrates a bone lengthening device affixed to a spine of a patient according to one embodiment; and

FIG. 43 illustrates a pair of bone lengthening devices affixed to a spine of a patient according to another embodiment.

DETAILED DESCRIPTION OF THE INVENTION

The present invention may be understood more readily by reference to the following detailed description taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this invention is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed invention. Any and all patents and other publications identified in this specification are incorporated by reference as though fully set forth herein.

In describing this invention, the word “coupled” is used. By “coupled” is meant that the article or structure referred to is joined, either directly, or indirectly, to another article or structure. By “indirectly joined” is meant that there may be an intervening article or structure imposed between the two articles which are “coupled”. “Directly joined” means that the two articles or structures are in contact with one another or are essentially continuous with one another. By adjacent to a structure is meant that the location is near the identified structure.

Also, as used in the specification including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment.

Turning now to the drawings, FIG. 1 is a schematic illustration of a bone lengthening device, generally referenced as 100, in accordance with the prior art wherein the components for translating rotational motion into linear motion are configured in series as further discussed hereinbelow. FIG. 1 depicts the prior art device 100 in a non-extended configuration. Prior art device 100 includes an outer rod 102 housing a rotational actuator 104 directly coupled in series to an externally threaded lead screw 106 which is in threaded engagement with an inner rod 108. Rotational actuation of lead screw 106 causes inner rod 108 to extend relative to outer rod 102. In the context of the present invention, the prior art configuration wherein the rotational actuator 104, lead screw 106, and threaded inner rod 108 are arranged as seen in FIG. 1 shall be construed as a configuration with said components mechanically arranged in “series.” As best seen in FIG. 1 , the mechanical configuration wherein the rotational actuator 104 and lead screw 106 are fixedly housed in series within the outer rod 102 results in a device having an excessive overall length.

FIGS. 2-32 disclose various embodiments of an implantable bone lengthening/elongating device various methods of using same in accordance with the present invention. FIG. 2 provides a schematic illustration of a bone lengthening device, generally referenced as 200, in accordance with the present invention. More particularly, bone elongating device 200 includes an inner rod 202 housing a rotational actuator 204 configured to drive a lead screw 206 which in turn is in treaded engagement with an internally threaded surface 208 b of an outer rod 208. As best seen in FIG. 2 , the mechanics for translating and ensuring rotational motion into linear motion, namely the lead screw 206 and threaded inner surface 208 b of outer rod 208, and outer rod 208 surrounding inner rod 202, are configured in “parallel” relative to rotational actuator 204, thereby resulting in significant reduction in overall length when compared with series configured devices known in the prior art. Inner rod 202 and outer rod 208 are preferably fabricated from surgical grade stainless steel. In some embodiments inner rod 202 and outer rod 208 may be tubular, however, in other contemplated embodiments inner rod 202 and outer rod 208 may be of different configurations provided that they are configured in a manner that allows for rotational motion to be converted to relative linear motion.

There are significant differences between bone lengthening devices configured in “parallel” vs. “series.” Devices configured in series in accordance with the prior art have the rotational actuator disposed within the outer rod and driving a lead screw in threaded engagement with a threaded inner surface of the inner rod. In contrast, devices configured in parallel in accordance with the present invention have the rotational actuator disposed within the inner rod and configured to drive a lead screw in threaded engagement with a threaded inner surface of the outer rod. Housing the rotational actuator (as well as other components) in the inner tube results in a device having a more compact length as compared with prior art devices.

As best seen in FIGS. 3A and 3B, an implantable bone lengthening device 200 in accordance with the present invention includes an inner rod 202 disposed in the inner cavity, referenced as “C” defined by an interior volume of outer rod 208. Inner rod 202 is telescopically disposed at least partially within an inner cavity C of the outer rod 208 and preferably includes an end portion 202 a partially projecting from outer rod 208 which terminates at an opposing end 208 a. Inner rod 202 is tubular and defines and internal volume housing at least a rotational actuator 204. A lead screw 206 is disposed at the opposite end of the inner rod 202 from end portion 202 a and is rotationally coupled to rotational actuator 204. Lead screw 206 is generally cylindrical and defines a threaded outer peripheral surface 206 a configured for threaded mating engagement with a threaded inner surface 208 b of outer rod 208 which surrounds inner cavity C. FIGS. 3C and 3D provide schematic detailed views of the threaded inner surface 208 b of outer rod 208 and the threaded outer surface 206 a of lead screw 206. The threads may be of any suitable shape and dimension; thread pitch, helical angle, thread angle, and crest/root dimension, so long as the threads of the lead screw 206 reliably engage with the threads 208 b formed on the inner surface of outer rod 208. In some embodiments, the threads are metric iso triangular, (a portion of a metric iso triangular profile, a metric trapezoidal, a UTS profile). In some embodiments, the thread pitch is 0.4 mm, in other embodiments the tread pitch may differ, preferably falling within a range from 0.05 mm to 2.0 mm. Bone lengthening device preferably fabricated with an overall retracted length of 120.0 mm, and diameter of 8.0 mm, a stroke length of 50 mm, and capable of generating an axial force of 600 Newtons. As should be apparent, variations of those dimensions may be made without departing from the scope of the present invention.

Rotational actuator 204 drives lead screw 206 to rotate relative to inner rod 202. Outer rod 208 is restricted, as more fully discussed herein below, from rotating relative to inner rod 202 but is otherwise free to move axially along the length of the inner rod 202. Actuation of rotational actuator 204 causes the lead screw 206 to rotate thereby causing outer rod 208 to move axially relative to inner rod 202. Accordingly, selective actuation of rotational actuator 204 extends the length of implantable bone lengthening device 200 when the lead screw rotates in a first direction, and reduces the length of the implantable bone lengthening device 200 when the rotational actuator 204 causes screw 206 to rotate in the opposite direction.

In some embodiments, the rotational actuator 204 includes an electric motor configured to provide a rotational movement to the lead screw 206 upon activation by an electrical signal. In other embodiments, the rotational actuator 204 includes a cylindrical magnet (e.g. magnetically actuated motor) configured to generate rotational movement to the lead screw 206 upon activation by an externally generated magnetic field. Further, any suitable apparatus for generating rotational actuation of lead screw 206 is considered within the scope of the present invention.

As illustrated in FIG. 4 , in some embodiments the rotational actuator 204 may comprise an electrical motor or a cylindrical magnet 204 a, or any other suitable actuator apparatus. In addition, the actuator assembly may further include a reducer 204 b coupling the motor or the magnet 204 a to lead screw 206. Reducer 204 b functions to increase the torque of the rotational actuator (e.g. a miniature motor) to a desired torque for driving lead screw 206 while maintaining an acceptable speed. In some embodiments, the reducer 204 b includes a gear assembly or gear box, such as a planetary gearbox. In some embodiments, the reducer 204 b includes a strain wave gear reducer. In some embodiments, the reducer 204 b includes a hypocycloid reducer. In some embodiments, the reducer 204 b includes any two of: planetary gearing, strain wave reducer, and/or hypocycloid reducer. In some embodiments, the reducer 204 b includes all three of: planetary gearing, strain wave reducer, and hypocycloid reducer.

As best seen in FIG. 5 , inner rod 202 may further house an electronics package 210, such as powering electronics, sensors, motor drivers, controller. As further illustrated in FIG. 6 , inner rod 202 may include a rotational actuator 204, an electronics package 210, and an electrical power source 212. Electrical power source 212 may include a battery, primary cell, a wireless power receiver, or any other suitable apparatus capable of receiving and/or delivering electrical power. In a contemplated alternate embodiment shown in FIG. 7 , power may be supplied to the device, such as the electronics package 210 housed within inner rod 202, via an electrically conducting cable 213 electrically connected to an implantable remote power module 214. Remote power module 214 may comprise an energy storage device such as a battery or a primary cell and may further optionally some electronics. Electrically conducting cable 213 may include a connector or be mechanically attached either at bone elongating device 200 or at power module 214. As seen in Figure FIG. 7 , electrically conducting cable 213 may be connected axially to the inner rod 202 of the one elongating device 200, or alternatively may be connected radially, or by any other suitable connection configuration. Electrically conducting cable 213 may embed powering cable of the device and wireless communication antenna. In another contemplated embodiment implantable remote powering module 214 may comprise a wireless power receptor, and optionally some electronics.

With reference to FIG. 8 , there is discloses an embodiment of an implantable bone lengthening device 200 further including a bearing 216 capable of operation when exposed to axial and/or radial forces. Bearing 216 withstands forces applied between the inner rod 202 and lead screw 206 allows rotational movement of the lead screw 206 relative to the inner rod 204. Bearing 216 further transmits axial and/or radial forces applied to the outer rod 208 through lead screw 206 to the inner rod 202. Bearing 216 may comprise a thrust bearing, such as a thrust ball bearing, a thrust roller bearing, tapered roller bearing, a thrust needle bearing, or a thrust plain bearing. In other contemplated embodiments bearing 216 may comprise a radial bearing, such as a radial ball bearing, a radial roller bearing, a radial needle bearing or a radial plain bearing. In other contemplated embodiments bearing 216 is an angular contact bearing, such as an angular contact ball bearing, an angular contact conical roller bearing, or a plain angular contact bearing. In still other contemplated embodiments, bearing 216 may comprise a combination of more than one bearing, or a combination of more than one bearing and bearing type such as a combination of several axial, radial and angular contact bearings. Further bearing 216 may comprise a single row bearing, double row bearing, or bearing(s) designed for forces applied in one or more directions.

FIGS. 9A and 9B depict yet another embodiment adapted with a seal 218. Seal 18 functions to hermetically seal the device whereby biocompatible components which can be in direct contact with patient tissues are separated by seal 18 from non-biocompatible components which must be isolated from patient tissues. Seal 218 may be used in conjunction with one or more of the bearing configurations disclosed herein. FIG. 9A illustrate use of a seal 218 disposed adjacent to lead screw 206 between the output shaft of rotational actuator 204 and inner rod 202. FIG. 9B illustrates use of seal 218 disposed between the inner rod 202 and the outer rod 208 in proximity to the projecting end of inner rod 202. Seal 218 may comprise, consists essentially of, or consist of an O-ring. In other contemplated embodiments seal 218 comprises, consists essentially of, or consists of an X-ring. In yet other embodiments seal 218 comprises, consists essentially of, or consists of an O-ring, X-ring, V-ring, leap-seal or any other shape seal.

Referring now to FIG. 10 , outer rod 208 may be adapted to include a vent 220 placing inner cavity C in fluid communication with the environment exterior to outer rod 208. Vent 220 operates to prevent a pressure differential (e.g. pressure reduction or vacuum) from forming across the wall of the outer rod 208 as the outer rod is advanced axially along the inner rod 202 as the inner cavity C expands. Vent 220 may further allow for cavity C to be filled with air or a gas at implantation. Vent 220 may be formed by a through bore or may further include fluid communication via channels formed in outer rod 208.

As illustrated in FIGS. 11 and 12 , implantable bone lengthening device may be configured wherein the projecting end portion 202 a of inner rod 202 has an external diameter that is approximately the same as, is the same as, or is greater than the external diameter of outer rod 208. In those embodiments, a sleeve 222 may extend from the end portion 202 a of inner rod 202 over the outer rod 208, to prevent growth of tissue in the gap, referenced as GP, that forms between the end portion 202 a and the outer rod 208 as the outer rod 208 moves axially along the inner rod 202 as shown in FIG. 12 . Sleeve 222 may be fabricated from surgical grade steel, or any other suitable material, and the outer rod slides freely within the sleeve or sheath. As illustrated in FIGS. 12B and 12C, in another embodiment the sleeve 222 has an elastic behavior and is attached both to the end portion 202 a of the inner rod and to the outer rod 208, sleeve 222 may be a soft elastic material or a hard material configured in a deformable structure such as a lattice pattern structure.

In an embodiment shown in FIG. 13 , a bushing 224 is disposed in outer rod 208 in proximity to the projecting end portion 202 a of inner rod 202. Bushing 224 functions to ensure proper alignment of the inner rod 202 and the outer rod 208, and to reduce or minimize play between inner rod 202 and outer rod 208. In addition, bushing 224 functions to reduce friction between components to ensure smooth sliding of outer rod 208 on inner rod 202.

Referring now to FIG. 14 , the projecting portion 202 a of the inner rod 202 may include a filleted end profile F to reduce or minimize abrasion damage to tissue surrounding the implantable bone lengthening device 200. The end portion 208 a of the outer rod 208 may also include a filleted end profile F′ to reduce or minimize abrasion damage to tissue surrounding the implantable bone lengthening device 200.

FIG. 15 provides a detailed partial sectional view illustrating the sliding engagement between inner rod 202 and outer rod 208. The threads formed on the inner surface of the outer rod 208 are in sliding engagement with the generally smooth outer surface of the inner rod 202 in order to make outer rod 208 slide properly on inner rod 202. Inner rod 202 and outer rod 208 are formed with precise tolerances in order to maximize a balance between friction and play. In some embodiments, the lead screw 206 includes a metric iso triangular thread form. In some embodiment the outer rod 208 includes a portion of a metric iso triangular thread form.

FIGS. 16A, 16B, and 17 depict embodiments of a bone lengthening device in accordance with the present invention adapted with opposing ends configured to facilitate attachment of the device to bone. With reference to FIG. 16A, bone lengthening device 200 includes the inner rod end portion 202 a and the outer rod end portion 208 a each define a through-bore 226 through which a bone screw or other suitable fastener or attachment device may be fed to attach the opposing ends of bone lengthening device 200 to corresponding sections of bone. FIG. 16B illustrates an alternate embodiment wherein the inner rod end portion 202 a and the outer rod end portion 208 a each define a pair of longitudinally aligned through-bores 226, each of which is intended to receive a bone screw or other suitable fastener or attachment device may be fed to attach the opposing ends of bone lengthening device 200 to corresponding sections of bone. FIG. 17 illustrates yet another embodiment wherein inner rod 202 and the outer rod 208 are adapted with lateral fixation plates 228, each of which define a pair of through bores 226. As should be apparent, inner rod 202 and the outer rod 208 may be configured with a variety of through-bore and fixation plate configurations. Further the through-bores may be axially aligned or axially offset and may be dispose at various aligned or non-aligned angles.

Referring now to FIGS. 18A and 18B, one advantage of bone lengthening devices 200 in accordance with the present are illustrated. In the comparative views shown in FIGS. 18A and 18B, the bone lengthening device 200 of the present invention has a minimum (e.g., fully retracted) length L2 that is significantly shorter than the minimum (e.g., fully retracted) length L1 of a bone lengthening device 100 consistent with the prior art, while having the same stroke length S and guiding length G. The shorter overall retracted length is important as it allows the bone lengthening device 200 of the present invention to be used on smaller bones present when treating pediatric patients.

FIGS. 19A and 19B, illustrate another advantage of bone lengthening device 200. In these comparative views, the stroke length S2 of a bone lengthening device 200 in accordance with the present invention is significantly longer than the stroke length 51 of a bone lengthening device 100 of the prior art that has the same minimum (e.g., retracted) length L and the same guiding length G. FIGS. 20A-20B illustrate another advantage of bone lengthening devices 200 in accordance with the present invention. In these comparative views, guiding length G2 of a bone lengthening device 200 consistent with the present disclosure is significantly longer than the guiding length G1 of a bone lengthening device 100 of the prior art that has the same minimum (e.g., retracted) length L and the same stroke length S.

FIGS. 21A and 21B, illustrate yet another advantage of bone lengthening device 200 of the present disclosure. In this comparative view, the space 204′ available for a rotational actuator in a bone lengthening device 200 of the present disclosure (FIG. 21B) is substantially greater than the space 104′ available for an actuator in systems of the prior art (FIG. 21A).

FIG. 22 illustrates a bone lengthening device 200 of the present disclosure used as intramedullary lengthening device. Referring to FIG. 23 , the bone lengthening devices 200 of the present disclosure can be use as extramedullary lengthening devices. Referring to FIG. 24 , the bone lengthening devices 200 of the present disclosure when used as extramedullary lengthening devices can be associated with an intramedullary stiffener 400. Referring to FIG. 25 , the bone lengthening devices 200 of the present disclosure can be used as a lengthening plate. In some embodiments, the implantable bone lengthening device 200 is an intramedullary retrograde nail, while in other embodiments the implantable bone lengthening device is an intramedullary antegrade nail.

In the case represented by the FIG. 26 , the implantable bone lengthening device 200 is powered by an integrated power source as disclosed above and wirelessly communicates with the external control unit 300. Wireless communications may include transmission of signals to external and/or from control unit 300, or some other electronic monitoring and/or control device. In addition, wireless communications may include receipt by device 200 of transmitted signals from external control unit 300, or some other electronic monitoring and/or control device. FIG. 27 illustrates the implantable bone lengthening device 200 receiving power using an integrated power receiver as disclosed above whereby device 200 is wirelessly powered by, and communicates wirelessly with, the external control unit 300. In accordance with this embodiment, electrical power is wirelessly transmitted to device 200 via external control unit 300. FIG. 28 illustrates an embodiment wherein implantable bone lengthening device 200 is powered by a remote powering module 214 (equipped with a power storage and/or a battery power source) and wirelessly communicates with an external control unit 300. In the case represented by the FIG. 29 , the implantable bone lengthening device 200 is powered by the remote powering module 214 which is equipped with a power receiver to receive energy wirelessly from external control unit 300, whereby electrical energy may be supplied to device 200 via electrically conducting cable 213. This embodiment further includes (a) the capability of wired communication between device 200 and module 214; (b) wireless communication between module 214 and external control unit 300. The present invention further contemplates that cable 213 my further include at least a portion thereof configured as a wireless communications antenna. As should be apparent, the control unit 300 provides a signal to the implantable bone lengthening device 200 (e.g., to the rotational actuator 204) to rotate the lead screw 206. In some embodiments, the signal includes sufficient information to cause the rotational actuator 204 to rotate the lead screw 206 by a predetermined amount (e.g., by a predetermined rotational degree of the lead screw 206, a predetermined axial movement of the outer rod 208, a predetermined torque or a predetermined force). In some embodiments, the signal includes a power component, such as a voltage wave or some alternating current waves.

FIGS. 30A and 30B are sectional views of a bone lengthening device 200 in accordance with the present invention illustrating the device in retracted and extended configurations respectively and further illustrating 50.0 mm of travel between the retracted and extended configurations. FIGS. 31A and 31B are sectional perspective views depicting bone lengthening device 200 in retracted and extended configurations. Bone lengthening device 200 includes an inner rod 202 and an outer rod 208 disposed in telescopically expandable relation. Housed within inner rod 202 there is an actuating assembly 204 which includes a motor 204 a driving a gear box 204 b which in turn drives lead screw 206. A bearing 216 and seal 218 are disposed between gearbox 204 b and lead screw 206. Inner rod 202 further houses an electronics package 210 which is in electronic communication with motor 204 a via electrical connection on one side thereof, and a sensor 230 via electrical connection on an opposing side thereof. Sensor 230 functions to detect and measure axial forces applied to the bone lengthening device 200. Device 200 further includes a proximal axial stop 232 and an antegrade axial stop 234. Proximal axial stop 232 functions to close off the proximal extremity of the device and retain axial pulling forces. For example, when a surgeon applies a tensile force to the end 202 a of inner rod 202 the force is transmitted to the outer rod 208 via lead screw 206, bearing 216, and axial stop 232. The antegrade axial stop 234 is associated with sensor 230. FIG. 32 is an exploded perspective cross-sectional illustrations of a bone lengthening device in accordance with the present invention.

In a contemplated alternate embodiment, implantable bone elongating device may further include a vibration sensor configured to detect vibration patterns linked to callus stiffness and/or to implantable bone elongation device performance.

Turning now to FIG. 33 , there is depicted structure for restricting rotational movement between the inner and outer rods, namely the outer surface of the inner rod 202 defines one or more radially outwardly projecting and longitudinally disposed lugs, referenced as 240, and the inner surface of outer rod 208 defines one or more radially inwardly projecting and longitudinally disposed channels, referenced as 242. Lugs 240 are received within channels 242 when the inner rod 202 is operatively engaged with outer rod 208. FIG. 34 is a cross-sectional illustration showing inner rod 202 disposed within outer rod 208 with lugs 240 slidably received within channels 242. As should be apparent with lugs 240 received within channels 242, the inner 202 and outer rod 208 are capable of longitudinal telescopic expansion and contraction while being prevented from rotation relative to each other. FIG. 35 provides an additional longitudinal sectional view of the device illustrating the inner rod lugs 240. Lugs 240 and channels 242 may extend substantially the entire length of the device 200 or may extend only partially, and further may be continuous formed in spaced segments. FIG. 36A is a cross-sectional view taken along line 36A-36A in FIG. 35 illustrating a channel 242 formed in the partially threaded inner surface of the outer rod 208. FIG. 36B is a cross-sectional view taken along line 36B-36B in FIG. 35 illustrating the partially threaded inner surface of the outer rod 208. FIG. 37A illustrates through bores 226 disposed at opposing ends the device 200 wherein the through bores are longitudinally spaced and in axial parallel alignment, and FIG. 37B is a perspective view thereof. FIG. 38A is a side view illustrating an alternate through bore configuration wherein through bores at opposing ends of device 200 longitudinally spaced with axis angularly offset, and FIG. 38B is a perspective view thereof. FIG. 39 is a side view illustrating through bores configured at perpendicular and oblique angles.

FIG. 40A is a side sectional view highlighting the proximal axial stop 232 and the distal axial stop 234 proximal axial stop, and FIG. 40B is a perspective sectional view thereof. FIG. 41 illustrates an alternate embodiment configuration of a bone elongating device, generally referenced as 300. Alternate embodiment bone elongating device 300 has substantially identical components and functions as bone elongating device 200, but further includes longitudinally disposed projecting flanges, referenced as 302. Each flange 302 defines one or more through bores 304 which function to receive fasteners or sutures (not shown) to affix device 300 to bone.

Methods of Lengthening Bones

Implantable bone lengthening devices 200 consistent with the present disclosure may be used to lengthen a bone of a subject in need thereof, such as a pediatric subject. In general, methods of lengthening a bone in a subject in need thereof comprise: associating (e.g., implanting) an implantable bone lengthening device 200 as disclosed herein with a bone of the subject that requires lengthening, activating the rotational actuator 204 a of the implantable bone lengthening device 200 to lengthen the implantable bone lengthening device 200, waiting a period of time for bone formation (e.g., callus bone) to occur, and repeating the activation and waiting steps until the bone has been lengthened a desired amount. In some embodiments, the method further comprises removing the implantable bone lengthening device 200 from the subject after the bone has been lengthened the desired amount.

In some embodiments, the step of associating the implantable bone lengthening device 200 comprises inserting the bone lengthening device 200 into a medullary cavity of a bone. In some embodiments, the medullary cavity is expanded (e.g., drilled) to accommodate the diameter and/or the length of the implantable bone lengthening device 200. The step of associating (e.g., implanting) the implantable bone lengthening device 200 may further comprise anchoring the inner rod 202 to the bone, for example by one or more bone screws, bone anchors, and/or sutures; and anchoring the outer rod 208 to the bone, for example by one or more bone screws, bone anchors, and/or sutures. In some embodiments, the step of anchoring the inner rod 202 to the bone comprises driving one or several bone screws through one or several holes 226. In some embodiments, the step of anchoring the inner rod 202 to the bone comprises driving two or more bone screws through the holes 226 through lateral fixation plate 228 associated with the inner rod 202. In some embodiments, the step of anchoring the outer rod 208 to the bone comprises driving one or several bone screws through one or several holes 226 of the outer rod 202. In other embodiments, the step of anchoring the outer rod 208 to the bone comprises driving two or more bone screws through the holes 226 through lateral fixation plate 228 associated with the outer rod 202.

As shown in FIG. 22 , the step of associating the implantable bone lengthening device 200 with the bone B may comprise inserting the implantable bone lengthening device 200 into the medullary cavity of the bone B. In other embodiments, such as those consistent with FIG. 23 , the step of associating the implantable bone lengthening device 200 with the bone B comprises attaching the implantable bone lengthening device 200 with the external surface (e.g., cortical surface) of the bone B. In such embodiments bone screws or threading sutures (not shown) are driven or passed through through-bores 226 of the inner rod 202, and by driving bone screws or threading sutures through the holes 226 of outer rod 208, using for example the embodiment depicted in previously discussed FIG. 17 .

As illustrated in the embodiment depicted in FIG. 24 , in an extramedullary configuration of the device 200, a stiffener 400 may be intramedullary associated with the bone B to provide stabilization and rigidity. Stiffener 400 is sized, shaped, and associated with the bone B to further stabilize the bone B by reducing or eliminating the risk of the bone B bending along its length. In some embodiments, the method further comprises performing a corticotomy and/or an osteotomy on the bone before associating the implantable bone lengthening device 200 with the bone.

The step of activating the rotational actuator 204 comprises sending an electrical signal to the rotational actuator 204, for example from the control unit 300, to cause the lead screw 206 to extend the outer rod 208 by a predetermined distance relative to the inner rod 202. The predetermined distance could be from 0.01 mm to 2.0 mm, however, any suitable distance is considered within the scope of the present invention. In some embodiments, the step of activating the rotational actuator 204 comprises sending an electrical signal to the rotational actuator 204, for example from the control unit 300, to cause the lead screw 206 to extend the outer rod 208 by a predetermined force relative to the inner rod 202. The predetermined force could be from IN to 3000N. In some embodiments, the step of activating the rotational actuator 204 comprises sending an electrical signal to the rotational actuator 204, for example from the control unit 300, to cause the lead screw 206 to extend the outer rod 208 by a predetermined force derivative relative to the inner rod 202. The predetermined force variation (i.e. derivative could be from 4 N/mm to 50000 N/m. This step of activating the rotational actuator to either extend outer rod 208 by a predetermined distance or to apply a predetermined force is preferably repeated in a sequential predetermined manner.

In some embodiments, the step of activating the rotational actuator 204 comprises sending an electrical distraction signal to the rotational actuator 204 from the control unit 300. The distraction signal causes the lead screw 206 to extend the outer rod 208 by a combination of predetermined distance, force and force variation. In some embodiments predetermined distance, force and force variation can be achieved with a predetermined speed or a predetermined time, or a maximum/minimum speed or time. In some embodiments, the step of waiting a period of time to enable formation of callus bone comprises waiting from few seconds to several hours or even days. In some embodiments, the step of activating the rotational actuator and the step of waiting a period of time to enable callus bone to form operate together to distract the bone about 0.25 mm per day to about 2 mm per day. The steps of activating the rotational actuator and waiting for a period of time are repeated until the bone has been lengthened by a desired amount. The desired amount of lengthening will vary from subject to subject, and from bone to bone.

In some embodiments, the present disclosure provides a method of lengthening a bone B of a subject in need thereof, the method comprising: (a) associating an implantable bone lengthening device 200 as disclosed herein with a bone B of the subject; (b) activating the rotational actuator 204 to advance the outer rod 208 relative to the inner rod 202 by a predetermined distance, force, force derivative, speed and/or time; (c) waiting a period of time to enable formation of callus bone; and (d) repeating steps (b)-(c) until the bone B has lengthened by a desired length. In some embodiments, the method further comprises forming or expanding a medullary cavity in the bone before the step of associating the implantable bone lengthening device 200 with the bone B. In some embodiments, the method further comprises associating a stiffener 400 with the bone B to further stabilize the bone B. In some embodiments, the step of associating the implantable bone lengthening device 200 with the bone B comprises inserting the implantable bone lengthening device 200 into a medullary cavity in the bone B. In some embodiments, the step of associating the implantable bone lengthening device 200 with the bone B comprises attaching the implantable bone lengthening device 200 to an exterior surface of the bone B. In some embodiments, the subject is a pediatric subject. In some embodiments, in some embodiments, the bone B is a lower limb bone the bone B is an upper limb bone.

The invention includes embodiments where the invention is an apparatus for correction of a Scoliotic curve in a spine comprising an inner rod and a tubular outer rod isolated completely under the skin; attachment screws to couple the said inner rod and said tubular outer rod to the spine wherein an end of said inner rod is coupled to a first vertebra, and an opposing end of said outer rod is coupled to a second vertebra; further comprising rotational actuator housed within said inner rod, to longitudinal extend the device over an extended defined period of time under external control until a desire spinal curve is obtained as otherwise generally set forth herein above. The apparatus is combined with an external or implantable source of power, and in one embodiment the device further comprises a link with sensor means allowing the measurement of the driving force, and/or the elongation vector as disclosed herein. In one embodiment of the invention, the said sensor means is composed of at least one strain gauge for Force measurements. In one embodiment of the invention, the sensor means is composed of at least one accelerometer for displacement measurements. More generally, where the invention is characterized as a combination of a tubular outer rod, an inner rod, attachment screws, a rotational actuator housed in the said inner rod, where a lead screw rotationally coupled to said rotational actuator, said lead screw in threaded engagement with the threaded inner surface of said outer rod produces a force over a defined period of time until the spine to which the force is steadily applied straightens at least to a partial degree.

FIG. 42 illustrates bone lengthening device 200 affixed to a spine, referenced as “S”, within the body, referenced as “B”, of a patient according to one embodiment. An external control and telemetry unit, referenced as 400, is positioned outside the patient body, and functions to control rotation actuator and wirelessly communicate with sensors associated with device 200. The sensors associated with bone lengthening device 200 are preferably integrated in device 200 and can deliver key information to the surgeon relating to device 200 and its environment including: bone lengthening stroke; spine deformity correction (angles, lengths, vectors, etc.); device temperature; regenerated bone stiffness; strain applied on device 200; and, strain applied to the spine “S”. One embodiment of the invention includes the ability for the surgeon to update patient protocol by after taking into account the key information data from the device 200 and its environment such scoliotic curve spine and its correction. In practice, the surgeon modifies relevant parameter(s) defined in the software embedded in the telemetry unit 400. The telemetry unit 400 transmits to the actuator device 200 the updated control/command. A remote power unit 214, such as a battery, provides electrical power to device 200. In a preferred embodiment, the control & telemetry unit 400 communicates with the bone lengthening device 200 by wireless communications, such as Bluetooth low energy technology.

FIG. 43 illustrates a pair of bone lengthening devices, referenced as 200A and 200B, affixed to a spine “S” of a patient according to another embodiment. As disclosed above, an external control and telemetry unit, referenced as 400, is positioned outside the patient body, and functions to control rotation actuator and wirelessly communicate with sensors associated with device 200. The sensors associated with bone lengthening device 200 are preferably integrated in device 200 and can deliver key information to the surgeon relating to device 200 and its environment including: bone lengthening stroke; spine deformity correction (angles, lengths, vectors, etc.); device temperature; regenerated bone stiffness; strain applied on device 200; and, strain applied to the spine “S”. One embodiment of the invention includes the ability for the surgeon to update patient protocol by after taking into account the key information data from the device 200 and its environment such scoliotic curve spine and its correction. In practice, the surgeon modifies relevant parameter(s) defined in the software embedded in the telemetry unit 400. The telemetry unit 400 transmits to the actuator device 200 the updated control/command. A single remote power unit 214, such as a battery, provides electrical power to both devices 200A and 200B. In a preferred embodiment, the control & telemetry unit 400 communicates with the bone lengthening device 200 by wireless communications, such as Bluetooth low energy technology.

The foregoing descriptions of specific embodiments of the present invention have been presented for purposes of illustration and description. They are not intended to be exhaustive or to limit the invention to the precise forms disclosed, and obviously many modifications and variations are possible in light of the above teaching. The embodiments were chosen and described in order to best explain the principles of the invention and its practical application, to thereby enable others skilled in the art to best utilize the invention and various embodiments with various modifications as are suited to the particular use contemplated. It is intended that the scope of the invention be defined by the Claims appended hereto and their equivalents.

It is to be understood that both the foregoing descriptions are exemplary and explanatory only, and are not restrictive of the methods and devices described herein. In this application, the use of the singular includes the plural unless specifically stated otherwise. All patents, patent applications, publications, and references cited herein are expressly incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. 

What is claimed is:
 1. An implantable bone elongating device comprising: an inner rod having an outer surface; an electronics package housed within said inner rod; an outer rod in telescopic engagement with said inner rod, said outer rod having a threaded inner surface in axial slidable engagement with the outer surface of said inner rod; said inner rod and said outer rod each having an end configured for attachment to bone; a rotational actuator housed within said inner rod; and a lead screw in axial alignment with said rotational actuator and rotationally coupled thereto, said lead screw in threaded engagement with the threaded inner surface of said outer rod; whereby rotational motion of said actuator is converted into linear motion, resulting in telescopic changes in an overall axial length of the device.
 2. The implantable bone elongating device according to claim 1, wherein said rotational actuator comprises an electric motor.
 3. The implantable bone elongating device according to claim 1, wherein said rotational actuator comprises a non-electric actuator activated by an externally generated magnetic field.
 4. The implantable bone elongating device according to claim 1, wherein the rotational actuator further includes a reducer.
 5. The implantable bone elongating device according to claim 1, wherein said electronics package contains an electrical power source.
 6. The implantable bone elongating device according to claim 1, further including a force sensor configured to detect axial force applied to the device.
 7. The implantable bone elongating device according to claim 1, wherein said inner rod further includes an externally disposed sleeve extending from an end portion thereof.
 8. The implantable bone elongating device according to claim 1, wherein said bone comprises a first vertebra and a second vertebra.
 9. An implantable bone elongating device comprising: an inner rod defining an internal volume; an outer rod in telescopically adjustable engagement with said inner rod, said outer rod defining an internal cavity bounded by a threaded inner surface; said inner rod and said outer rod each having an end configured for attachment to bone; an electronics package disposed within said internal volume; a rotational actuator in electrical communication with said electronics package; said rotational actuator including a motor and a gear assembly; a lead screw coupled to said gear assembly, said lead screw having a threaded external surface disposed in threaded engagement with the threaded inner surface of said outer rod; and means for activating said rotational actuator to selectively cause telescopic extension or retraction of the device.
 10. The implantable bone elongating device according to claim 9, wherein said means for activating includes an implantable remote power module in electrical communication with said electronics package.
 11. The implantable bone elongating device according to claim 9, wherein said means for activating includes an external control unit adapted for wireless communication with said electronics package.
 12. The implantable bone elongating device according to claim 11, wherein said external control unit further includes means for transmitting electrical power to said electronics package.
 13. The implantable bone elongating device according to claim 9, wherein said outer rod, said inner rod, said rotational actuator, and said lead screw are configured in parallel, and mechanics thereby translate rotational motion into linear motion.
 14. An implantable device for treatment of a scoliotic curve in a spine of a subject, said implantable device comprising: an inner rod; an electronics package housed within said inner rod; a tubular outer rod in telescopic engagement with said inner rod, said outer rod having a threaded inner surface in axial slidable engagement with said inner rod; said inner rod and said outer rod each having an end configured for attachment to bone; a rotational actuator housed within said inner rod; a lead screw rotationally coupled to said rotational actuator, said lead screw in threaded engagement with the threaded inner surface of said outer rod; whereby rotational motion of said actuator is converted into linear motion, resulting in changes in an overall length of the implantable device; and said bone including a first vertebra and a second vertebra.
 15. The implantable device according to claim 14, wherein said end of said inner rod is configured for attachment to at least two vertebra and wherein said end of said outer rod is configured for attachment to at least two vertebrae.
 16. The implantable device according to claim 15, further including a single powering unit for providing electrical power. 